The Effect of Drowning in a Bathtub on Erythrocytes in Victims / 日本温泉気候物理医学会雑誌

ABSTRACT

<p>  <b>Objective</b> The aim of the present study was to investigate the effect of bathtub drowning on erythrocytes in victims. </p><p>  <b>Methods</b> Thirty-nine consecutive victims with CPA were included in the present study and consisted of 16 males and 23 females, 8-95 years of age, median 78 years old. Data on the arrival examination were analyzed, which consisted of serum sodium (Na) and chloride (Cl), hematocrit (Ht)/hemoglobin (Hb) ratio, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). In addition, the changes of MCV level in accordance with treatment in two bathtub drowning victims, one who was resuscitated and the other who had been under treatment in our hospital, were compared with those in two water intoxication patients.</p><p>  <b>Results</b> Of the 39 victims, 18 showed serum Na levels to be lower than normal range (NR) but no victim showed one higher than NR. In serum Cl level, 22 victims showed levels below NR but no one showed a level above NR. As to the value for the Ht/Hb ratio, the ratios were within NR in only three victims and were above NR in the rest. In MCH, three victims showed levels below NR and one victim showed a level above NR. In MCV, 16 victims showed levels above NR but no one showed a level below NR. The comparison of MCV between drowning victims and water intoxication patients pointed out a difference in the effect on treatment in cases of drowning, MCV increased only on the day of the event and returned to baseline the next day, whereas in cases of water intoxication, MCV remained unchanged for a few days after treatment and then increased. </p><p>  <b>Conclusion</b> It is well known that freshwater drowning induces both hyponatremia and hypochloremia, which are caused by water transferred from alveoli to blood vessels. The increased MCV in bathtub drowning victims is induced by the expansion of erythrocytes through lower osmotic pressure, which exceeds the decreased change in hematocrit due to hemodilution, although the mechanism of the change in MCV in water intoxication cases is not identified.</p>